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Three exclusively breastfed male infants (Case 1, 3 months; Case 2, 7 months; and Case 3, 6 months of age) presented to our emergency department with vomiting, bilateral non-fatiguable ptosis and altered sensorium in form of lethargy, excessive crying and moaning (figures 1 and 2). Ophthalmic examination in addition revealed abduction deficits. There was no nystagmus. The rest of CNS examination was unremarkable. Maternal dietary history was notable for a diet consisting of polished rice as a …
Contributors UAQ was involved in workup, KA supervised, IA and MI wrote the manuscript, and NAW provided the images.
Competing interests None.
Patient consent Obtained.
Ethics approval Hospital ethics committee.
Provenance and peer review Not commissioned; internally peer reviewed.
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